Comprehensive Unit Based Safety Program    A webinar series for QI Managers, Nurse Leaders and others supporting healthcare improvement in Wisconsin’s hospitals    July 2012

A Four Part Series Part I – July 10th The Science of Safety and forming the CUSP team Part II – August 7th The Staff Safety Assessment & Safety Huddles Part III – September 4th Identifying Defects Part IV – October 2nd Learning from Defects 2

Objectives for the Series 1.Understand what CUSP is and it’s components. 2.Understand how to apply CUSP components in practice. 3.Understand the vital importance that a patient safety focus has on a unit. 4.Gain access to resources related to the adoption of CUSP. 3

Who is Participating in This Series? Any hospital enrolled in WHA’s Partners for Patients collaborative. QI Departments planning to adopt CUSP approaches house wide Units actively implementing CUSP Disclaimer information here… 4

Participation in the Webinar Series Levels of Participation Level A – Learning about the CUSP model. Participants may be QI/Risk Management or Nursing staff or leaders. Level B - Implementing the aspects of the CUSP model as well as completing webinar specific homework. Participants may include QI/Risk Managers and Nurses. Level C – Convening a Safety Team for learning and implementing the CUSP model. (Or involving an already existing Safety Team) At a minimum, Safety Team consists of CNO, Executive, Unit Manager, Physician and staff. 5

Process for the Webinar Series Learn content through webinar – Receive follow-up materials Complete “next steps” from each webinar Receive mid-month check-up tool » Intended as a reminder 6

What is CUSP? 7

The Vision of CUSP The Comprehensive Unit-based Safety Program (CUSP) is a safety culture program designed to: – educate and improve awareness about patient safety and quality of care – empower staff to take charge and improve safety in their work place – partner units with a hospital executive to improve organizational culture and provide resources for unit improvement efforts – provide tools to investigate and learn from defects 8

CUSP History CUSP was started at Johns Hopkins Hospital in the 1990’s Keystone project – Michigan initiative – 75 hospitals, 127 ICUs In collaboration with Johns Hopkins Quality and Safety Research Group Reduce errors and improve patient outcomes in ICUs Combination of evidence based medicine and quality improvement Five interventions implemented over a two year grant funded period Still going strong!!!! 9

All Units, All the Time 10 This is a Standardized approach NOT just for BSI. STOP FALLS STOP VAP STOP CAUTI

Form a unit CUSP team with executive sponsorship Measure unit culture Educate staff on Science of Safety Identify defects using the Staff Safety Assessment; prioritize defects Learn from one defect per quarter Implement team/communication tools Keep focus on this throughout the journey!!!

Why CUSP Works It focuses on culture. It integrates safety practices into daily work. It translates. It has easier buy-in. It brings accountability. It keeps leaders grounded. 12

Measuring Unit Culture 13

Getting there isn’t easy “The soft stuff is always harder than the hard stuff.” -- Richard Enrico, CEO PepsiCo,

Why Focus on Culture? Because culture is local, it must be targeted at the unit level, with support at the organizational level. Frontline staff know the hazards facing their patients and are capable of identifying solutions and plans to address specific problems. 15

Safety Culture Safety Culture encompasses the attitudes held within a workplace, from the leadership to the front lines. This includes: How open staff is to discussing patient safety issues and concerns with their colleagues and their leaders How safe they feel about speaking out if they think that a patient is in danger How serious they think the organizational leadership is about patient safety How well they think they work as a team. 16

The Age-Old Question: 17 How do we measure culture? Surveys are a simple, low cost way to (sort of) measure culture. (and it’s better than not knowing anything about your culture!)

Culture Assessment Important to measure your Safety Culture – Examples include AHRQ Hospital Survey on Patient Safety Culture, Press Ganey’s Safety Culture Survey Safety Culture survey results provide insight into frontline staff’s attitudes about patient safety within your organization. May give some indication of staff’s actual practices around patient safety. 18

Example of a Culture of Safety Survey AHRQ has made available the Hospital Survey on Patient Safety Culture (HSOPS) since 2004 Comparative Data is available 2007 – 2010 The 2010 database has 885 hospitals, and 338,607 staff responses. On average, hospitals submitted 383 completed surveys, for a response rate of 56%. 19

Very Different from “Satisfaction” 20 (But much more difficult to “fix”)

National Data Trends 21

Strengths and Areas for Improvement 22 Strengths for Most Hospitals Pct. Positive Needed Improvement for Most Hospitals Pct. Positive Teamwork within Units86%Non-punitive Response to Error44% Supervisor/Manager Expectations & Actions Promoting Patient Safety 75%Hand-offs and Transitions44% Overall Patient Safety Grade74%Number of Events Reported – Hospitals Reporting NONE 53% From the AHRQ Executive Summary

Wisconsin’s HSOPS Data Results to be shared during live webinar 23

What to do With the Results? Analyze and share survey results with unit staff as well as leadership. Many hospitals take these results to their Quality Council and/or Board of Trustees. Use as a baseline measurement prior to implementing CUSP. Use as a method of focusing on improvement/culture change. 24

Forming your CUSP team 25

Why Form a Team? One person can’t change a culture. Need a variety of perspectives. Leaders are removed from day-to-day interactions. Staff needs Leadership help to influence change. 26

CUSP Team Must be unit based – If you want to understand and impact unit culture and safety the team must include front line staff Representation from all types of staff members who provide direct patient care on a unit 27

Who to Include? At a minimum, the following staff should be on your CUSP team: – Team Leader/Safety – Physician – Executive Champion – Staff Nurse (ideally one from each shift) Other potential team members: – Nutritionist – Infection Preventionist – Quality Manager – Nurse Manager/Unit Leader – Pharmacist 28

Executive Partnership Executive sponsorship is key to the success of the CUSP team. Should be part of the CUSP team. Does not have to have a clinical background (consider asking your CFO, COO, etc). Executive Leadership should celebrate wins and provide encouragement, support, attention, and resources if there are set backs. 29

Educating Staff on the Science of Safety 30

Medical errors most often result from a complex interplay of multiple factors. Only rarely are they due to the carelessness or misconduct of single individuals Lucien L. Leape, MD Harvard School of Public Health 31

People are fallible Medicine is still treated as an art, not science Need to view the delivery of healthcare as a science Need systems that catch mistakes before they reach the patient How Can These Errors Happen? 32

Why Mistakes Happen? 33 Variable input (diff pts) Inconsistency/variation Complexity Too many/complicated steps Human intervention Tight time constraints Hierarchical culture Fatigue Inattention/distraction Unfamiliar situations/new problem Using past solutions Equipment design flaws Communications errors Mislabeling/inadequate instructions Process FactorsPeople Factors

System Failure Leading to This Error 8. Pronovost PJ, Wu Aw, Sexton, JB et al., Ann Int Med, Reason J, Hobbs A.,

System Factors Impact Safety Hospital Departmental Factors Work Environment Team Factors Individual Provider Task Factors Patient Characteristics Institutional Adapted from Vincent BMJ 35

Understand the Science of Safety Every system is perfectly designed to achieve the results it gets Understand principles of safe design – standardize, create checklists, learn when things go wrong Recognize these principles apply to technical and team work Teams make wise decisions when there is diverse and independent input How Can We Improve? 36 Caregivers are not to blame

Standardize – Eliminate steps if possible Create independent checks Learn when things go wrong – What happened? – Why? – What did you do to reduce the risk? – How do you know it worked? 37 Principles of Safe Design

What Happens When We Focus on Patient Safety? 38

% of respondents within an ICU reporting good teamwork climate Teamwork Climate Across Michigan ICUs No BSI 21% No BSI 21% No BSI 44% No BSI 44% No BSI 31% No BSI 31% No BSI = 5 months or more w/ zero The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care Health Services Research, 2006;41(4 Part II):

The Science of Safety Resources Webinar Follow Up Materials (will be sent out in a follow up ) Link to Science of Safety video CUSP Toolkit Key messages for CUSP team sponsorship – Bedside staff – Project leaders – Executive Champion 40

The Science of Safety Homework In the next 30 days: Decide who should be involved in a CUSP/Safety team. Confirm a CUSP/Safety team membership and convene the team. To educate staff, have everyone view the Science of Safety Video. Review culture survey baseline data or conduct a culture survey. Plan to attend Part II (The Staff Safety Assessment & Safety Huddles) webinar on August 7 th for next steps. 41

The Science of Safety Check Up Mid-month Check Up Via a web survey Questionnaire sent out on July 27th Did you convene a CUSP/Patient Safety team? How many staff viewed the Science of Safety video? Do you have a baseline safety culture? Did the CUSP/Patient Safety team review the results of your hospitals most recent safety culture survey results? Were there any areas for improvement detected? Do you have an ongoing process (informal or formal) used to review these results? 42

Additional Resources 43 AHRQ Safety Survey Tools: CUSP Resources:

Thank You Questions? Jill Hanson & Stephanie Sobczak Wisconsin Hospital Association 44